DSD newsletter interview with Atachai Phunkron, SWING, Thailand (Nov 2021)

We spoke with Atachai Phunkron, counsellor and head of the care and support unit at the Service Workers In Group (SWING) Foundation, Thailand, to learn more about the role of lay health workers in providing integrated HIV and sexually transmitted infection (STI) services, as well as referral systems and same-day treatment initiation.

Photo: Service delivery at SWING (by Kanya Sirikhum, Care and Support Officer, SWING).

Atachai, please tell us about your work as a counsellor at SWING.

In 2011, I started working at SWING in Bangkok. Working in the financial unit, I participated in various trainings and meetings, which helped me expand my HIV knowledge. When SWING opened a community-based clinic providing HIV and STI screening services in 2014, I worked as a counsellor there and received training from the Institute of HIV Research and Innovation (IHRI).

Today, I counsel clients who receive positive results on HIV and STI tests. I help them understand treatment and the referral process into treatment. I also counsel clients who use other services at SWING, such as testing, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). Further, I coordinate capacity-building activities for our clinic with the treatment network in the Bangkok area.  

What are the key things to know about SWING’s approach to HIV and STI service delivery?

All services we deliver are centred on clients’ needs and tailored to specific populations. All are delivered by community providers. Our clinics provide health screening services for a variety of health issues and we’ve adapted clinic times to respond to clients’ lives. Other services and activities can be adjusted and delivered through mobile clinics and outreach activities. We also keep in touch with clients after the service has been provided. Recipients can keep in touch with each other on the online platform. This is an important aspect of SWING’s work that should be maintained and developed.

The outreach unit identifies those who are at risk and provides risk reduction counselling, condoms and lubricants, and information on facilities that offer HIV and STI screening services. In addition to three HIV screening clinics, SWING has a mobile clinic for identifying clients and facilitating health check-up services, for example, in bars, massage parlours and saunas.

The clinic-based unit works as a community-based health facility, providing HIV and STI screening services. Various screening and testing services are available at our clinic, such as for HIV, syphilis and hepatitis C virus. Previously, there was a screening service for gonorrhoea and chlamydia, which was part of a research study that ended in September 2021. If a client’s HIV status is confirmed, CD4 levels can be immediately tested. The SWING clinic also offers PrEP and PEP services. Lastly, we provide counselling for feminizing hormone level measurement in transgender women who take hormones for gender affirmation to facilitate safe use.

The care and support unit refers clients to treatment according to their insurance scheme. If clients are diagnosed with HIV, they are referred to initiate antiretroviral therapy (ART). If STIs are detected, clients are referred for treatment accordingly. The unit also provides physical, mental and social counselling. And once clients are initiated on ART, the unit follows up on their ART adherence and viral load level. Regarding information services, there are staff who provide information, online and offline, to reach key populations.

Have there been any adaptations to SWING’s service delivery model due to COVID-19?

In response to the COVID-19 outbreak, SWING adapted the workflow at each point to minimize impact on staff and clients. We increasingly moved to online platforms to create as many contact channels as possible, focus on reaching new clients and retain our current clients in services while minimizing face-to-face contact. Regarding clinical services, we followed the practical guidelines in strict compliance with Ministry of Public Health guidance. SWING contributed to providing relief bags, including food and basic necessities, to people struggling to maintain their livelihoods during the COVID-19 pandemic.

What are the key lessons learnt from implementing key population-led health services and what are the next steps?

Through the STI point-of-care (POC) study, we tested men who have sex with men and transgender women for gonorrhea and chlamydia with the point-of-care machines at community-based organizations. Community staff were trained to dispense chlamydia drugs in community clinics to clients diagnosed with chlamydia. It showed that early detection and quick treatment was possible and could be provided by the community-based service and community providers. Unfortunately, prescribing chlamydia drugs at SWING ended with the STI POC study.

We need to scale up key population-led health services, for example, through expansion of our service unit. The referral system that links clients to treatment works well, but treatment is currently not provided at the SWING clinic and we have to rely on network partners for this. We hope to get support from other medical facilities to follow our suggestions in redesigning the referral service according to the needs of the community.

In a few months, an implementation science study on same-day ART will be extended to both SWING clinics in Bangkok. The community has been looking forward to testing and treatment taking place in community-based clinics.